
Explore the revenue cycle management process in health care from credentialing to payment collection and reimbursement. Master billing, coding, insurance verification, and accounts receivable to improve cash flow.
Learn how credentialing and enrollment form the revenue cycle foundation, covering provider and facility credentialing, NPI, CV, licenses, and in-network fee schedule processes.
Register patients by collecting demographics and insurance details, scheduling, verifying benefits, and handling referrals or prior authorizations, using a user-friendly practice management system with potential future automation.
Verify patient demographics and eligibility at check-in, collect copays and past-due balances, code services with CPT and ICD-10 in the EHR/EMR, and place patients on a recall list.
Submit claims by completing charge entry in the EMR/EHR, scrub and validate codes, then submit via EDI or paper through a clearinghouse, and monitor electronic reports.
Analyze electronic remittance advices (ERA 835) and explanation of benefits to read EOB data, credits, and patient responsibility. Learn how integrated posting tools streamline ledger updates and reflect contract terms.
Explore denial management within revenue cycle management, covering coordination of benefit denials, coding denials, duplicate denials, referrals and prior authorization, eligibility, and filing limit denials.
Choose between in-house printing and electronic delivery via a clearinghouse, patient portal, or text payments for patient statements. Prioritize electronic delivery to cover patient responsibilities.
Identify and follow up on unpaid claims, diagnose denials, and pursue appeals within revenue cycle management; address not on file claims and authorization or referral issues to optimize payments.
Master patient collection within the revenue cycle by implementing in-house protocols after 90–120 days, using letters and calls, offering payment plans, and deciding when to transfer to a collection agency.
This course provides an in-depth look at the revenue cycle management process in healthcare. Students will gain a comprehensive understanding of the revenue cycle, from provider credentialing, patient registration, scheduling to payment collection and reimbursement. Topics covered include billing and coding, insurance verification, claim submission, accounts receivable management, and patient collection. The course will also provide an overview of the major government and commercial payers, and introduce strategies for improving the efficiency of the revenue cycle. Upon completion of this course, students will be able to effectively manage their organization's revenue cycle, increase cash flow, and identify areas of improvement
The course emphasizes strategies for optimizing the efficiency of the revenue cycle process and increasing cash flow for healthcare organizations. Students will learn how to identify areas of improvement and implement solutions to maximize revenue and reduce costs.
Upon completion of the course, students will be equipped with the necessary knowledge and skills to effectively manage the revenue cycle process in their healthcare organization. They will have a comprehensive understanding of the entire revenue cycle and be able to identify and implement strategies to improve revenue collection, reduce payment delays, and increase overall efficiency.
About Me:
I am a highly experienced Revenue Cycle Manager and Billing Manager with 25 years in the healthcare industry. I have an extensive knowledge of medical billing, coding and reimbursement processes and is an expert in developing strategies to maximize revenue and minimize denials. I have a proven track record of success and is a sought-after speaker and lecturer on the subject. I am passionate about helping healthcare organizations optimize their revenue cycle and billing processes.